Neonicotinoids Impact All Aspects of Bird Life: A Meta-Analysis.

Worldwide, bird populations are declining dramatically. This is especially the case in intensely used agricultural areas where the application of neonicotinoid insecticides is thought to-unintendedly-cause a cascade of negative impacts throughout food webs. Additionally, there could be direct (sub-) lethal impacts of neonicotinoids on birds, but to date there is no comprehensive quantitative assessment to confirm or rule out this possibility. Therefore, we use a meta-analytical approach synthesising 1612 effect sizes from 49 studies and show that neonicotinoids consistently harm bird health, behaviour, reproduction, and survival. Thus, in addition to reduced food availability, the negative direct effects of exposure to neonicotinoids likely contribute to bird population declines globally. Our outcomes are pivotal to consider in future risk assessments and pesticide policy: despite localised bans, the metabolites and residues of neonicotinoids remain present in the environment and in birds and will thus have long-lasting direct effects on both the individual and the population levels.

Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life.

Background/Objectives: Chronic unilateral vestibular hypofunction (UVH) can lead to disabling vestibular symptoms and a decrease in quality of life. The aim of this study was to investigate etiologies, clinical subtypes, symptoms, and quality of life (QoL) in patients with chronic UVH. Methods: A retrospective study was performed on 251 UVH patients in a tertiary referral center. Inclusion criteria comprised reduced or absent caloric responses, with a caloric asymmetry ratio ≥25%. Patients with central vestibular pathology, symptom duration <3 months, and incomplete responses to questionnaires were excluded. Patient records were assessed for etiologies, secondary vestibular diagnoses, clinical subtypes, and questionnaires related to QoL. Additionally, multiple linear regression analysis was performed to evaluate factors influencing QoL. Results: Thirteen different etiologies were identified, with Menière's Disease as the most prevalent (31%, n = 79). The most frequently reported secondary vestibular diagnoses were benign paroxysmal positional vertigo (BPPV) (21%, n = 54) and persistent postural perceptual dizziness (PPPD) (19%, n = 47). Five distinct clinical subtypes were identified: recurrent vertigo with UVH (47%), rapidly progressive UVH (25%), idiopathic/unknown UVH (18%), slowly progressive UVH (8%), and congenital UVH (2%). Over 80% of UVH patients experienced moderate-to-severe handicap, as indicated by the Dizziness Handicap Inventory. Approximately 20-25% of UVH patients exhibited moderate-to-severe depression and anxiety, based on the Hospital Anxiety and Depression Scale. Multiple linear regression analyses demonstrated that the presence of PPPD significantly reduced QoL in chronic UVH patients. Conclusions: Chronic UVH is a heterogeneous disorder. Secondary vestibular diagnoses like BPPV and PPPD often co-exist and can significantly impact QoL. A structured diagnostic approach and tailored interventions are crucial to address the diverse needs of UVH patients.

Acute stress promotes effort mobilization for safety-related goals.

Although the acute stress response is a highly adaptive survival mechanism, much remains unknown about how its activation impacts our decisions and actions. Based on its resource-mobilizing function, here we hypothesize that this intricate psychophysiological process may increase the willingness (motivation) to engage in effortful, energy-consuming, actions. Across two experiments (n = 80, n = 84), participants exposed to a validated stress-induction protocol, compared to a no-stress control condition, exhibited an increased willingness to exert physical effort (grip force) in the service of avoiding the possibility of experiencing aversive electrical stimulation (threat-of-shock), but not for the acquisition of rewards (money). Use of computational cognitive models linked this observation to subjective value computations that prioritize safety over the minimization of effort expenditure; especially when facing unlikely threats that can only be neutralized via high levels of grip force. Taken together, these results suggest that activation of the acute stress response can selectively alter the willingness to exert effort for safety-related goals. These findings are relevant for understanding how, under stress, we become motivated to engage in effortful actions aimed at avoiding aversive outcomes.

Shifting Views on Cancer Pain Management: A Systematic Review and Network Meta-Analysis.

CONTEXT: Strong opioids are the cornerstone in the treatment of cancer-related pain. OBJECTIVES: This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain. METHODS: PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks. RESULTS: Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP. CONCLUSION: The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain.

The association of glucose metabolism measures and diabetes status with Alzheimer's disease biomarkers of amyloid and tau: A systematic review and meta-analysis.

Conflicting evidence exists on the relationship between diabetes mellitus (DM) and Alzheimer's disease (AD) biomarkers. Therefore, we conducted a random-effects meta-analysis to evaluate the correlation of glucose metabolism measures (glycated hemoglobin, fasting blood glucose, insulin resistance indices) and DM status with AD biomarkers of amyloid-ß and tau measured by positron emission tomography or cerebrospinal fluid. We selected 37 studies from PubMed and Embase, including 11,694 individuals. More impaired glucose metabolism and DM status were associated with higher tau biomarkers (r=0.11[0.03-0.18], p=0.008; I2=68%), but were not associated with amyloid-ß biomarkers (r=-0.06[-0.13-0.01], p=0.08; I2=81%). Meta-regression revealed that glucose metabolism and DM were specifically associated with tau biomarkers in population settings (p=0.001). Furthermore, more impaired glucose metabolism and DM status were associated with lower amyloid-ß biomarkers in memory clinic settings (p=0.004), and in studies with a higher prevalence of dementia (p<0.001) or lower cognitive scores (p=0.04). These findings indicate that DM is associated with biomarkers of tau but not with amyloid-ß. This knowledge is valuable for improving dementia and DM diagnostics and treatment.

The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis.

BACKGROUND: Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. METHODS: We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. RESULTS: SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. CONCLUSIONS: Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.

Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged Forty and over: A Three-Level Meta-Analysis and Systematic Review of Randomized Controlled Trials.

Computer-tailored health communication (CTC) can enhance fruit and vegetable (F&V) intake and, consequently, health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. This research aimed to assess the 12-mo efficacy of CTC in promoting F&V consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code CRD42022330491. The research was performed without external funding. We searched 6 databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing F&V intake with usual care/no intervention control in adults aged ≥40, measured 12 mo after the pretest. The search covered the period from 1 January 1990 to 1 January 2022. We selected 16 RCTs with 25,496 baseline participants for the review systematic literature reviews (SLR) and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed risk of bias with the JBI Critical Appraisal Checklist. The SLR revealed that at 1-y postCTC intervention, most of the treatment groups increased F&V intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for F&V consumption in intervention groups compared with control, standardized mean difference of 0.21 (confidence interval [CI]: 0.12, 0.30), P = 0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase F&V intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change.

Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity: The SELFIE Randomized Clinical Trial.

Importance: Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending. Objective: To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only. Design, Setting, and Participants: This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity. Interventions: A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only. Main Outcomes and Measures: The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning. Results: A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = -3.78; 95% CI, -6.59 to -0.98; P = .008; Cohen d = -0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = -1.71; 95% CI, -2.93 to -0.48; P = .006; Cohen d = -0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = -0.33; 95% CI, -0.59 to -0.03, P = .01, Cohen d = -0.27), general psychopathology (B = -17.62; 95% CI, -33.03 to -2.21; P = .03; Cohen d = -0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed. Conclusions and Relevance: A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision. Trial Registration: Dutch Trial Register Identifier:NL7129(NTR7475).

Multistep estimators of the between-study covariance matrix under the multivariate random-effects model for meta-analysis.

A wide variety of methods are available to estimate the between-study variance under the univariate random-effects model for meta-analysis. Some, but not all, of these estimators have been extended so that they can be used in the multivariate setting. We begin by extending the univariate generalised method of moments, which immediately provides a wider class of multivariate methods than was previously available. However, our main proposal is to use this new type of estimator to derive multivariate multistep estimators of the between-study covariance matrix. We then use the connection between the univariate multistep and Paule-Mandel estimators to motivate taking the limit, where the number of steps tends toward infinity. We illustrate our methodology using two contrasting examples and investigate its properties in a simulation study. We conclude that the proposed methodology is a fully viable alternative to existing estimation methods, is well suited to sensitivity analyses that explore the use of alternative estimators, and should be used instead of the existing DerSimonian and Laird-type moments based estimator in application areas where data are expected to be heterogeneous. However, multistep estimators do not seem to outperform the existing estimators when the data are more homogeneous. Advantages of the new multivariate multistep estimator include its semi-parametric nature and that it is computationally feasible in high dimensions. Our proposed estimation methods are also applicable for multivariate random-effects meta-regression, where study-level covariates are included in the model.

Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis.

Objective: To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms. Methods: A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions. Results: A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation. Conclusion: A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].

Motivation to stop smoking in the German population between 2016 - 2021 and associated factors: results from a repeated cross-sectional representative population survey (German Study on Tobacco Use, DEBRA study).

OBJECTIVES: We aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the validated German version of the Motivation To Stop Scale (MTSS) are associated with sociodemographics, nicotine dependence, past quit attempts, and use of e-cigarettes and tobacco product alternatives. METHODS: We used data from the German Study on Tobacco Use: an ongoing repeated cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We analysed data from 18 969 adult current smokers with multivariable ordinal regression and described MTSS scores between 2016 and 2021 (scores 1-7=lowest to highest level of motivation). RESULTS: The mean MTSS score was 2.04 (SD=1.37) and showed a slight downward trend over time. Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, no previous waterpipe use and current or past e-cigarette use were associated with higher MTSS scores. The largest effect estimates were observed for at least one quit attempt 0-6 months ago versus no attempt in the past year (OR=7.54; 95% CI 6.78 to 8.40), at least one quit attempt 7-12 months ago versus no attempt in the past year (OR=4.00; 95% CI 3.59 to 4.45) and for current versus never use of e-cigarettes (OR=1.71; 95% CI 1.48 to 1.99). CONCLUSIONS: Recent quit attempts and current use of e-cigarettes were associated with higher motivation to stop smoking in the German population. Actions to boost the general motivation to stop smoking are required.

Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression.

BACKGROUND AND AIMS: Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions. METHODS: A systematic review and meta-regression was conducted including 172 randomised controlled trials with at least 6 months follow-up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta-regression was used to create a model predicting smoking cessation outcomes. This model was used to re-estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta-regression models and smoking cessation differences and ratios to compare relative effectiveness. RESULTS: The meta-regression model predicted smoking cessation rates well (pseudo R2 = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self-help was 1.33 times (95% CI = 1.16-1.49), brief physician advice 1.61 times (95% CI = 1.31-1.90), nurse individual counselling 1.76 times (95% CI = 1.62-1.90), psychologist individual counselling 2.04 times (95% CI = 1.95-2.15) and group psychologist interventions 2.06 times (95% CI = 1.92-2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness. CONCLUSIONS: Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components.

A mixed-method investigation into measurement reactivity to the experience sampling method: The role of sampling protocol and individual characteristics.

Since the introduction of the experience sampling method (ESM), there have been concerns that the repeated assessments typically related to this method may alter the behavior, thoughts, or feelings of participants. Previous studies have offered mixed results with some studies reporting reactive changes, while others failed to find such effects. Our aim was to investigate under which circumstances ESM induces reactive effects. Students (N = 151) were randomly assigned to receive a questionnaire containing 30 or 60 items three, six, or nine times per day for 14 days. A random sample of 50 participants took part in qualitative interviews after the end of the data collection. We investigated changes over time in the data, while taking into account the sampling protocol and characteristics of participants, and analyzed qualitative reports of measurement reactivity. Decreases in completion time, within-person variance of ratings and subjective reports of habituation point toward the existence of a habituation period. While participants reported increases in emotional awareness in interviews, ESM measures indicated a decrease in emotional awareness over time. Changes in behavior were rare in quantitative and qualitative reports. Positive affect was decreasing over time in the ESM data, and various changes in affect, emotion regulation, and thoughts were reported in interviews. Individual characteristics and sampling protocol had inconsistent effects on changes over time. The results suggest that ESM induces changes in within-person variability, completion times, affect, or emotional awareness over time. Further research is needed to explore whether observed changes affect the validity of ESM data. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A robust and readily implementable method for the meta-analysis of response ratios with and without missing standard deviations.

The log response ratio, lnRR, is the most frequently used effect size statistic for meta-analysis in ecology. However, often missing standard deviations (SDs) prevent estimation of the sampling variance of lnRR. We propose new methods to deal with missing SDs via a weighted average coefficient of variation (CV) estimated from studies in the dataset that do report SDs. Across a suite of simulated conditions, we find that using the average CV to estimate sampling variances for all observations, regardless of missingness, performs with minimal bias. Surprisingly, even with missing SDs, this simple method outperforms the conventional approach (basing each effect size on its individual study-specific CV) with complete data. This is because the conventional method ultimately yields less precise estimates of the sampling variances than using the pooled CV from multiple studies. Our approach is broadly applicable and can be implemented in all meta-analyses of lnRR, regardless of 'missingness'.

A Comparison of Methods for Gene-Based Testing That Account for Linkage Disequilibrium.

Controlling the type I error rate while retaining sufficient power is a major concern in genome-wide association studies, which nowadays often examine more than a million single-nucleotide polymorphisms (SNPs) simultaneously. Methods such as the Bonferroni correction can lead to a considerable decrease in power due to the large number of tests conducted. Shifting the focus to higher functional structures (e.g., genes) can reduce the loss of power. This can be accomplished via the combination of p-values of SNPs that belong to the same structural unit to test their joint null hypothesis. However, standard methods for this purpose (e.g., Fisher's method) do not account for the dependence among the tests due to linkage disequilibrium (LD). In this paper, we review various adjustments to methods for combining p-values that take LD information explicitly into consideration and evaluate their performance in a simulation study based on data from the HapMap project. The results illustrate the importance of incorporating LD information into the methods for controlling the type I error rate at the desired level. Furthermore, some methods are more successful in controlling the type I error rate than others. Among them, Brown's method was the most robust technique with respect to the characteristics of the genes and outperformed the Bonferroni method in terms of power in many scenarios. Examining the genetic factors of a phenotype of interest at the gene-rather than SNP-level can provide researchers benefits in terms of the power of the study. While doing so, one should be careful to account for LD in SNPs belonging to the same gene, for which Brown's method seems the most robust technique.

Location-scale models for meta-analysis.

Heterogeneity is commonplace in meta-analysis. When heterogeneity is found, researchers often aim to identify predictors that account for at least part of such heterogeneity by using mixed-effects meta-regression models. Another potentially relevant goal is to focus on the amount of heterogeneity as a function of one or more predictors, but this cannot be examined with standard random- and mixed-effects models, which assume a constant (i.e., homoscedastic) value for the heterogeneity variance component across studies. In this paper, we describe a location-scale model for meta-analysis as an extension of the standard random- and mixed-effects models that not only allows an examination of whether predictors are related to the size of the outcomes (i.e., their location), but also the amount of heterogeneity (i.e., their scale). We present estimation methods for such a location-scale model through maximum and restricted maximum likelihood approaches, as well as methods for inference and suggestions for visualization. We also provide an implementation via the metafor package for R that makes this model readily available to researchers. Location-scale models can provide a useful tool to researchers interested in heterogeneity in meta-analysis, with the potential to enhance the scope of research questions in the field of evidence synthesis.

Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial.

INTRODUCTION/OBJECTIVE: This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU. METHODS: Individuals aged 15-65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. RESULTS: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ2(3) = 9.05; p = 0.033), and negative symptoms (χ2(3) = 19.91; p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (χ2(3) = 21.56; p < 0.001). CONCLUSIONS: INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.

Mental Health Symptoms and Associations with Tobacco Smoking, Dependence, Motivation, and Attempts to Quit: Findings from a Population Survey in Germany (DEBRA Study).

INTRODUCTION: This study aimed to estimate prevalence rates of mental health symptoms (anxiety, depression, and overall psychological distress) by tobacco smoking status, and associations between such symptoms and the level of dependence, motivation, and attempts to quit smoking in the German population. METHODS: Cross-sectional analysis of data from six waves of a nationally representative household survey collected in 2018/19 (N = 11,937 respondents aged ≥18). Mental health symptoms were assessed with the Patient Health Questionnaire-4. Associations with smoking status, dependence, motivation to quit, and ≥1 past-year quit attempt (yes/no) were analysed with adjusted regression models among the total group, and among subgroups of current (n = 3,248) and past-year smokers (quit ≤12 months ago, n = 3,357). RESULTS: Weighted prevalence rates of mental health symptoms among current, former, and never smokers were: 4.1%, 2.4%, 2.5% (anxiety), 5.4%, 4.7%, 4.0% (depression), and 3.1%, 2.5%, 2.4% (psychological distress). Current versus never smokers were more likely to report symptoms of anxiety and depression. Smokers with higher versus lower levels of dependence were more likely to report higher levels of all three mental health symptoms. Higher versus lower levels of overall psychological distress were associated with a higher motivation to quit smoking and, among past-year smokers, with higher odds of reporting a past-year quit attempt. CONCLUSIONS: We found various relevant associations between mental health symptoms and smoking behaviour. Healthcare professionals need to be informed about these associations and trained to effectively support this vulnerable group in translating their motivation into abstinence.

Intervention mechanisms of an experience sampling intervention for spousal carers of people with dementia: a secondary analysis using momentary data.

Objectives: A psychosocial intervention for spousal carers of people with dementia promoted emotional well-being through self-monitoring and personalized feedback, as demonstrated in a previous randomized controlled trial. The mechanism behind the intervention effects is thought to lie in increased awareness of, and thus, engagement in behaviours that elicit positive emotions (PA). This secondary analysis tests the assumption by investigating momentary data on activities, affect, and stress and explores the relevance of personalized feedback compared to self-monitoring only.Methods: The intervention was based on the experience sampling method (ESM), meaning that carers self-monitored own affect and behaviours 10 times/day over 6 weeks. The experimental group received personalized feedback on behaviours that elicit PA, while the pseudo-experimental group performed self-monitoring only. A control group was also included. ESM-data of 72 carers was analysed using multilevel mixed-effects models.Results: The experimental group reported significant increases in passive relaxation activities over the 6 weeks (B = 0.28, SE = 0.12, Z = 2.43, p < .05). Passive relaxation in this group was negatively associated with negative affect (r = -0.50, p = .01) and positively associated with activity-related stress (r = 0.52, p = .007) from baseline to post-intervention. Other activities in this or the other groups did not change significantly.Conclusion: Carer's daily behaviours were only affected when self-monitoring was combined with personalized feedback. Changing one's daily behaviour while caring for a person with dementia is challenging and aligned with mixed emotions. Acknowledging simultaneously positive and negative emotions, and feelings of stress is suggested to embrace the complexity of carer's life and provide sustainable support.